Intussusception

From Dog

Intussusception (telescoping intestine) in dogs is defined as a loop of intestine invaginated within an adjacent loop (intussuscipiens)[2].

This condition usually present in young dogs and may occur as a normograde (i.e., following the direction of peristalsis), although retrograde intussusceptions (e.g. pylorogastric[3]) have been documented. Most cases involve the ileocolic region, but enteroenteric, cecocolic, ileocecal, and colocolic intussusceptions have been reported.

Intussusception typically results in venous and lymphatic obstruction, with eventual arterial compromise. Some cases spontaneously resolve for unknown reasons[4].

The causes of intussusception include:

Clinical symptoms include vomiting, diarrhea (with hematochezia or melena), tachycardia and abdominal pain.

Blood tests usually reveal leukocytosis with neutrophilia, hyponatremia, hypochloremia and hypokalemia (due to vomiting and diarrhea)[8].

A presumptive diagnosis is often achieved based on clinical history, presenting signs, abdominal radiographs (including contrast radiography) and ultrasonography. On ultrasound visualisation, an intussusception can be seen as parallel lines of alternating hyper- and hypo-echoic lines ('bull’s eye' or target sign).

Treatment usually involves surgical correction of the intestinal accident, but medical management prior to surgery is critical. This includes aggressive intravenous fluid therapy, use of broad-spectrum antimicrobials (e.g. enrofloxacin and metronidazole), pain management (e.g. buprenorphine) and nutritional support.

Most surgeries are approach via laparotomy although gastroesophageal intussusceptions have been reduced endoscopically in young pups[9].

There appears to be little correlation between duration of intussusception and ease of manual reduction.

Enteroplication is usually required to prevent recurrence. In intussusceptions involving intestinal necrosis, an end-to-end resection and anastomis is of the devitalized intestines is usually required[10].

Careful evaluation of preserved surgical margins is important during enterectomy and enteroanastomosis and monitoring of digestive function after surgery are important[11].

The prognosis in most cases is good providing a rapid diagnosis is established and intervention initiated as soon as possible.

References

  1. Atray M et al (2012) Ultrasonographic diagnosis and surgical management of double intestinal intussusception in 3 dogs. Can Vet J 53(8):860-864
  2. Levitt L & Bauer MS (1992) Intussusception in dogs and cats: A review of 36 cases. Can Vet J 33:660–664
  3. Choi J et al (2012) Ultrasonographic findings of pylorogastric intussusceptions in two dogs. J Vet Sci 13(2):215-217
  4. Patsikas MN et al (2008) Spontaneous reduction of intestinal intussusception in five young dogs. J Am Anim Hosp Assoc 44(1):41-47
  5. Hanzlicek AS et al (2011) Canine schistosomiasis in Kansas: five cases (2000-2009). J Am Anim Hosp Assoc 47(6):e95-e102
  6. Levien AS & Baines SJ (2011) Histological examination of the intestine from dogs and cats with intussusception. J Small Anim Pract 52(11):599-606
  7. Allman DA & Pastori MP (2013) Duodenogastric intussusception with concurrent gastric foreign body in a dog: a case report and literature review. J Am Anim Hosp Assoc 49(1):64-69
  8. Weaver AD (1977) Canine intestinal intussusception. Vet Rec 100:524–527
  9. McGill SE et al (2009) Nonsurgical treatment of gastroesophageal intussusception in a puppy. J Am Anim Hosp Assoc 45(4):185-190
  10. White RN (2008) Modified functional end-to-end stapled intestinal anastomosis: technique and clinical results in 15 dogs. J Small Anim Pract 49(6):274-281
  11. Oliveira-Barros LM et al (2010) Histologic and immunohistochemical evaluation of intestinal innervation in dogs with and without intussusception. Am J Vet Res 71(6):636-642